Provider Demographics
NPI:1275788010
Name:ALABAMA PROFESSIONAL CARE INC
Entity Type:Organization
Organization Name:ALABAMA PROFESSIONAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:FOREST
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:877-827-6085
Mailing Address - Street 1:578 AZALEA RD
Mailing Address - Street 2:#119
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1551
Mailing Address - Country:US
Mailing Address - Phone:877-827-6085
Mailing Address - Fax:
Practice Address - Street 1:578 AZALEA RD
Practice Address - Street 2:#119
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1551
Practice Address - Country:US
Practice Address - Phone:877-827-6085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty